Housing Characteristics of Areas With More Falls by Older Adults Living in Single-Family Detached Dwellings: A Cohort Study Using Geospatial Analysis

Abstract

Objective: To identify geographic locations with high numbers of medically attended falls (ie, hotspots) by older adults and to test the associations between fall hotspots and resident/housing characteristics.

Patients and methods: In this cohort study, we retrospectively reviewed adults who were 65 years or older, lived in a single-family detached dwelling, and had a medically attended fall in Olmsted County, MN, between April 1, 2012, and December 31, 2014. We identified medically attended falls by using billing codes and confirmed by manual review of the electronic health records. We performed geospatial analysis to identify fall hotspots and evaluated the association between fall hotspots and resident or housing characteristics with logistic regression models, adjusting for age, sex, socioeconomic status, chronic health conditions, and/or a history of falls.

Results: Among 12,888 residents living in single-family detached dwellings in our community, 587 residents (4.6%) had documented accidental falls. Falls were more common in older residents and in women. Residents who had more chronic diseases, lower socioeconomic status, and a history of falls also had higher odds of a fall. Geospatial analysis identified 2061 (16.0%) residents who lived in a fall hotspot. Houses in hotspots were more likely to have more stories with fewer stairs (split level) (odds ratio [OR], 1.75; 95% CI, 1.57-1.94, for split level vs 1-story houses), smaller square feet (OR, 0.29; 95% CI, 0.24-0.35, for largest vs smallest houses), and in the highest quartile for age (OR, 1.46; 95% CI, 1.26-1.70, for oldest built vs newest built houses).

Conclusion: Falls were more common in locations in our community that had older, smaller homes and lower housing-based socioeconomic status. These findings can be used by clinicians to identify residents who are at higher risk for falls.

Figure 1

Kernel density map of observed falls among older adults living in single-family detached dwellings in Olmsted County, Minnesota. (© Esri, used under license terms.) The observed case density of falls among older adult residents living in single-family dwellings per square mile are indicated by color intensity.

Figure 2

Relative difference in observed and expected falls adjusted for age, sex, and housing-based socioeconomic status. (© Esri, used under license terms.) The relative difference was calculated as (observed falls − expected falls)/expected falls.

Figure 3

Revised fall hotspot map after adjusting for age, sex, and housing-based socioeconomic status. (© Esri, used under license terms.)